Four months after the coronavirus began sweeping through Oklahoma’s nursing homes, the federal government is preparing to ship thousands of tests to residential care facilities for the elderly and disabled nationwide. But even as single shipments are delivered, public access to the tests is dwindling as a result.
In a July 14 announcement, the Trump administration promised to provide rapid response tests to skilled nursing homes, which have seen some of the worst outbreaksin Oklahoma and nationally. Oklahoma providers have received little government assistance thus far and say help is long overdue.
Representatives at two Oklahoma clinics say it is already becoming more difficult to obtain the diagnostic tests, which provide results within minutes and are less invasive — and less reliable — than the polymerase chain reaction (PCR) test.
“It’s not that we don’t want long-term care providers to get the tests, but now they’re putting us in a crunch because we can’t get the tests we need,” said Julia Keltner, community engagement director at First Med Urgent Care. “This should have been planned a lot better, but now we’re in a pinch because the government just decided this all of a sudden and we had no time to prepare.”
First Med Urgent Care has five locations in Oklahoma City and Edmond and is the only Oklahoma clinic offering the rapid tests, Keltner said.
Kimberly Green, chief operating officer for Diakonos Group, which owns 20 long-term care facilities in Oklahoma, said the tests will help nursing homes quickly test staff and visitors, potentially lessening or preventing a likely second wave of infections. But a shortage of public tests could unravel that progress, she said.
“The community not having access to these tests will inevitably come back to our residents,” Green said. “It’s all connected so shifting away from the public to help us, doesn’t really help us. It’s very backwards.”
A Testing Trade-Off: Speed for Reliability
Rapid response tests are conducted by nasal swab. The swab is only inserted partway into the nostril and for a shorter time than the nasal polymerase chain reaction (PCR) test, which requires a deeper swab.
Testing machines allow clinics, and soon nursing homes, to analyze the rapid swab samples and receive results in less than an hour.
Jared Taylor, an epidemiologist contracted by the Oklahoma State Department of Health, said the tests provide relief to overwhelmed testing labs but the trade-off is reliability.
Positive results are more reliable than negative results, Taylor said. Rapid tests are reliable for detecting active COVID-19 cases but not for ruling infections out, he said.
Taylor says the tests are worthwhile but shouldn’t be considered a definitive diagnosis.
Health departments in Oklahoma are using some rapid tests mostly as benchmarks. For example, if a state employee is exposed but no one was showing symptoms, they might use rapid testing to determine if anyone was positive before subjecting all of the employees in the building to a polymerase chain reaction (PCR) test, which Taylor called the “gold standard.”
Rapid tests are a small percentage of the state’s overall testing, he said.
“They provide good, usable data quickly and that’s valuable,” Taylor said. “But that data requires other considerations to be taken, like symptoms and exposure.”
In the past four weeks, Michelle Leach, 51, has been tested three times for COVID-19. All three times she opted for the rapid test.
Leach, an accountant at HomeWorx Sales and Leasing in Edmond, said she had her first test after a co-worker became infected. Leach was positive. She had a low-grade fever and was a little achy but said her symptoms were minor. She quarantined for two weeks before returning to work.
Leach had two show two negative results before her gym would allow her to return. She had two more rapid tests done. Both were negative.
“It wasn’t bad. In fact, I wondered if she got enough on the sample the first time,” Leach said. “The second time they went a little further up and then the third time they went even further but none of them were that bad."
After the office outbreak, Leach’s employer set up an account with First Med to pay for optional rapid testing for its employees. The tests cost between $75 and $125.
Keltner, First Med’s business liaison, said the clinic partnered with about 100 businesses to streamline the testing and payment process for employees who wanted tests.
Employees could visit the clinic without an appointment, get tested from their car and receive the results on the same day. In many cases, workers who were exposed over the weekend could get tested and have the results by Monday and return to work Tuesday minimizing their time off, Keltner said.
But as more tests are diverted to nursing homes, fewer tests are available to clinics. That could lead to prolonged time off for cashiers at Love’s Travel Stops, mechanics at Discount Tire, warehouse workers at Niagara Water, servers at The Hutch OKC and car salesmen and women at David Stanley Auto Group in a lurch.
Kelter said the clinics can no longer guarantee immediate testing for workers of the 100 businesses. Employees will now have to make appointments online to get tested and may face two, three or four day waits to get in.
“It’s like they’re (the federal government) robbing Peter to pay Paul,” Keltner said.
Nursing Homes Braced for Tests, and Disappointment
Few details have been released about the distribution to nursing homes, which was scheduled to begin last week.
Shipments, including 400 swabs and an analysis machine, are being prioritized by the Centers for Medicare and Medicaid Services — the federal agency that oversees long-term care facilities. It is unclear what metrics are being used to decide who gets the supplies first or when the tests would reach Oklahoma’s skilled nursing homes.
Of the state’s 304 nursing homes, 290 are classified as skilled, according to the Oklahoma State Department of Health. Skilled homes house residents who require medical care from licensed health professionals like registered nurses or physical, speech, and occupational therapists.
Nursing home staff and industry representatives say skilled facilities have a greater risk of exposure to the virus because residents are frequently in and out of the hospital or other medical facilities for treatment instead of being isolated inside the home.
Green said she has no idea when the Diakonos facilities, including the hard-hit Franciscan Villa, will receive deliveries. In the meantime, she is buying up as many of the rapid test kits as she can in anticipation of a shortage.
“We get made lots of promises and lots of those have fallen short, so we want to be prepared,” Green said.
The 400 tests will go fast, Green said, especially if facilities conduct weekly testing of staff, which is recommended for homes reopening visitation.
Green said Diakonos plans to use the tests mostly for staff and visitors and will continue to rely on other, more reliable, tests for residents.
Will Tests Make Nursing Homes Safer?
The prioritization of rapid testing access to nursing homes won’t make a difference to Classen Urgent Care Clinic. Like others in the state, the Norman based clinic has struggled to get access to rapid testing since the pandemic began.
Manufacturers have told Hussein Torbati, the clinic’s managing director, that the federal government controls access to the tests. Torbati said for months he has been told that tests are being rerouted to places considered hotspots. Tests were going to New York, then New Orleans, then Arizona, then Texas, then Florida, he said.
“I don’t know how hot we are supposed to get before we actually get it,” Torbati said.
The clinic recently received the machine they requested in March that analyzes the swabs. But without the test kit the machine is useless, he said.
The clinic is currently using antibody testing as well as polymerase chain reaction (PCR) testing through external labs, which delays test results. What would take an hour at the clinic takes two to four days at some labs and 10 to 14 days at other sites.
Torbati said they could conduct at least 200 rapid tests a day if the kits were available.
Torbati said it is important testing the general public is part of the larger effort needed to keep nursing homes safe.
“It would be much better if we could prevent them from getting it by testing the people that are going to see them,” Torbati said. “In order to do that, clinics such as ours and others like ours need to have the ability to be testing the general public.”
